Domestic violence is a significant public health problem that requires a broad and integrated response across the wider health care system, including third sector organisations. Total health and societal costs are estimated by NSPCC to be £16bn. Identification and Referral to Improve Safety (IRIS) is an intervention programme, developed and tested using MRC Framework for Complex Interventions, to improve the primary care response to domestic violence. In a cluster randomised controlled trial within primary care practices in London and Bristol, it was shown that IRIS cost-effectively improved identification and referral.
However, important questions remain about implementation, which are being addressed in this project:
1. Outside of a trial context, is IRIS effective on a borough-wide scale?
2. How sustainable is the initial effect of IRIS with reinforcement?
3. How can the programme be extended beyond primary care and integrated to synergistically improve identification and management of domestic violence in other sectors of the health care system, including sexual health and gynaecological outpatient settings?
The project is a Phase IV implementation study using interrupted time series design across 200 east London general practices. The results of this project will benefit patients by determining:
1) the real-life impact of rolling out training in general practice on identification and referral of women experiencing domestic violence
2) the potential for extending training to sexual health clinics.